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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880910
Report Date: 04/27/2026
Date Signed: 04/27/2026 10:47:48 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241107163929
FACILITY NAME:K & J ADULT RESIDENTIALFACILITY NUMBER:
361880910
ADMINISTRATOR:HOLMAN, JERRHONDAFACILITY TYPE:
735
ADDRESS:5091 ROOSEVELT STTELEPHONE:
(562) 225-1038
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:4CENSUS: 2DATE:
04/27/2026
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Jerrhonda HolmanTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Staff made inappropriate comments about resident in resident’s presence
Staff did not provide resident with personal outing activities
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Jerrhonda Holman and explained the purpose of the visit regarding the allegations stated above.

First allegation: Staff made inappropriate comments about resident in resident’s presence. Regarding the allegation stated above, LPA conducted an interview with Client #2 regarding the alleged allegation Client #2 informed LPA that client has not witnessed staff making inappropriate comments to other clients. In addition, Client #2 informed LPA that clients have not witnessed staff making inappropriate comments in the presence of other clients. LPA conducted interviews with Staff #1, Staff #2, and Staff #3, regarding the alleged allegation stated above and Staff #1-3 denied the allegation and informed LPA that staff have not made inappropriate comments about Client #1 in the presence of Client #1 or in the presence of any client.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20241107163929
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: K & J ADULT RESIDENTIAL
FACILITY NUMBER: 361880910
VISIT DATE: 04/27/2026
NARRATIVE
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Second allegation: Staff did not provide resident with personal outing activities. Regarding the allegation stated above, LPA conducted an interview with Staff #4 regarding the alleged allegation Staff #4 informed LPA that recreational activities are provided to all clients. Staff #4 informed LPA that Client #1 was on a Diversion Plan ordered by the court ordering Client #1 to be placed in an Adult Residential Facility that will provide Client #1 with 24-hour care and supervision for two years. In addition, Staff #4 informed LPA that court order indicated that Client #1 is not to be out in the community independently or unsupervised. LPA conducted a record review and obtained a copy of Client #1 court order document. In addition, during the review of documentation LPA observed that Client #1 contacted Inland Regional Center to inform IRC that the allegations that were made against the facility were false. Based on corroborating evidence LPA has determined that the above allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Jerrhonda Holman.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2